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Multicenter Study
. 2018 Sep 15;52(3):1800079.
doi: 10.1183/13993003.00079-2018. Print 2018 Sep.

The dyspnoea-inactivity vicious circle in COPD: development and external validation of a conceptual model

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Free article
Multicenter Study

The dyspnoea-inactivity vicious circle in COPD: development and external validation of a conceptual model

Maria A Ramon et al. Eur Respir J. .
Free article

Abstract

The vicious circle of dyspnoea-inactivity has been proposed, but never validated empirically, to explain the clinical course of chronic obstructive pulmonary disease (COPD). We aimed to develop and validate externally a comprehensive vicious circle model.We utilised two methods. 1) Identification and validation of all published vicious circle models by a systematic literature search and fitting structural equation models to longitudinal data from the Spanish PAC-COPD (Phenotype and Course of COPD) cohort (n=210, mean age 68 years, mean forced expiratory volume in 1 s (FEV1) 54% predicted), testing both the hypothesised relationships between variables in the model ("paths") and model fit. 2) Development of a new model and external validation using longitudinal data from the Swiss and Dutch ICE COLD ERIC (International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts) cohort (n=226, mean age 66 years, mean FEV1 57% predicted).We identified nine vicious circle models for which structural equation models confirmed most hypothesised paths but showed inappropriate fit. In the new model, airflow limitation, hyperinflation, dyspnoea, physical activity, exercise capacity and COPD exacerbations remained related to other variables and model fit was appropriate. Fitting it to ICE COLD ERIC, all paths were replicated and model fit was appropriate.Previously published vicious circle models do not fully explain the vicious circle concept. We developed and externally validated a new comprehensive model that gives a more relevant role to exercise capacity and COPD exacerbations.

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Conflict of interest statement

Conflict of interest: A. Agustí reports receiving grants and personal fees from AstraZeneca, GSK and Menarini, grants from MSD, and personal fees from Novartis, Teva and Chiesi, outside the submitted work. Conflict of interest: R. Rodriguez-Roisin reports receiving grants from Almirall and Menarini, personal fees for service on an advisory board from Boehringer Ingelheim, Pearl Therapeutics and Teva, and lecture fees from Novartis and Takeda, during the conduct of the study, all related to COPD. Conflict of interest: J. Garcia-Aymerich reports payments to her institution for consulting and lecturing from AstraZeneca, and receiving lecture fees from Esteve and Chiesi, outside the submitted work.

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